Prioritization. Edwina Jones RN, BSN

Transcription

1 Prioritization Edwina Jones RN, BSN

2 Objectives Discuss the importance of prioritization as a component of time management. Understand the three basic steps in time management. Recognize priority-setting traps and understand how to avoid them. Understand how to rank priorities for individuals and apply this knowledge in the clinical setting. Know and apply the principles needed to rank priorities for a group of patients.

3 Objectives Understand the role of the RN in helping the interdisciplinary group address priority patient needs. Understand how proper prioritization can help the novice RN manage time at work more efficiently. Apply the suggestions for managing time at work and understand how they can improve patient outcomes. Recognize time-wasters and how to avoid them.

4 Introduction Setting priorities is an essential and critical thinking skill. Priority setting is perhaps the most critical skill in good time management, because all actions we take have some type of relative importance. Management of a patient load depends heavily on setting priorities.

5 Introduction The new nurse tends to focus on one problem at a time rather than seeing the whole picture, and may have difficulty in priority setting. Through the assessment process, patients help the nurse define their needs, establish interventions, and implement the plan of care. This is where individualized priority-setting between patients and nurses occurs.

6 Introduction By necessity some care needs will be delayed in preference to more pressing needs of other patients. Priorities will be influenced by the acuity of the patient s condition and the acuity of all patient s assigned to a nurse.

7 Time Management Three Basic Steps in Time Management Allow time for planning and establish priorities. Complete the highest priority task whenever possible, and finish one task before beginning another. Reprioritize based on the remaining tasks and on new information that may have been received.

8 Priority ranking of patients First level patient problems- these are threats to a patient s immediate survival or safety and demand immediate nursing intervention. ABC s (airway, breathing, circulation)

9 Priority ranking of patients Second level concerns such things as mental status change, acute pain, acute urinary elimination, untreated medical problems requiring immediate attention (diabetic needing insulin) abnormal pathology lab results, risks of infection, safety or security.

10 Priority ranking of patients Third level those that do not fit into the above two categories such as monitoring for medication side effects, lack of patient knowledge, longer-term problems with living activities, etc.

11 Priority ranking of patients When no life-threatening problems exist, the nurse used both professional judgment and the patient to set priorities and determine planning. This is a continually changing aspect of assessment of patients.

12 Additional Principles of Prioritization Know needs and priorities of each patient To identify which clients need assessment first, the nurse uses information from the change of shift report and the patients acuity level. After initial nursing assessments are completed, the nurse ranks individual client needs in terms of priority or urgency.

13 Additional Principles of Prioritization Consider all factors Available resources and staff Qualifications of staff What things can be delegated to others How much time is involved in some skills (things that take more time may be done later)

14 Additional Principles of Prioritization Always remain flexible During the course of the shift, priorities may need to be reevaluated and reorganized depending on changes in acuity levels, new admissions, etc.

15 Additional Principles of Prioritization Use of creativity Emphasize patient s s abilities and strengths so that they may learn to assume more self-care Encourage family participation in care

16 The interdisciplinary group The RN acts as a client advocate while working with all members of the interdisciplinary team. As the primary nurse, the RN has all of the information about the patient s s care priorities while the other members may look only at their area of expertise. (Ex. Physical therapy, respiratory therapy, speciality MD s, dieticians, etc.

17 Priority Setting Traps Whatever hits first - this trap occurs when an individual simply responds to things as they happen rather than thinking first and then acting. This is common to new nurses. Path of least resistance in this trap the individual makes the assumption that it is easier to do a task by himself or herself and fails to delegate appropriately.

18 Priority Setting Traps Squeaky wheel in this trap, the individual falls prey to those who are most vocal about their requests and then feels a need to respond to the time frame imposed by the squeaky wheel rather than his or her own. Default the individual feels obligated to take on tasks that no one else has come forward to do

19 Priority Setting Traps Inspiration in this trap, individuals wait until they become inspired to accomplish a task. Some tasks will never be inspiring, and the wise time manager recognizes that the only thing that will complete these tasks is hard work and appropriate attention to the matter.

20 Managing time at work Being overwhelmed by work and time constraints lead to increased errors, omission of important tasks, and general feelings of stress and ineffectiveness. Time management skills are learned although some people are better at it than others. Disorganization results from poor planning and prioritization.

21 Simple suggestions for time management Gather all the supplies and equipment that will be needed before starting an activity. Breaking down a job mentally into parts before beginning the activity may help the nurse identify what supplies are needed.

22 Simple suggestions for time management Group activities that are in the same location. If you have walked a long distance down a hallway, attempt to do several things there before going back to the nurses station. Another example is a home health nurse, group client visits geographically when possible to minimize travel time.

23 Simple suggestions for time management Document your nursing interventions as soon as possible after an activity is completed. Waiting until the end of the workday to complete necessary documentation increases the risk of inaccuracies and incomplete documentation.

24 Simple suggestions for time management Strive to end the workday on time. Although this is not always possible, delegating appropriately to others and making sure that the workload goal for any given day is reasonable are two strategies that will help accomplish this goal.

25 Simple suggestions for time management Schedule difficult tasks during the period of the day you are most productive and simpler, more routine tasks during less productive times.

26 Time Wasters Procrastination the three most common reasons for procrastination are: Not wanting to begin Not knowing where to begin Not knowing where to begin, even if you wanted to do, which you don t.

27 Time Wasters Poor planning Failure to establish goals and objectives Inability to delegate Inability to say no Management by crisis Haste Indecisiveness

28 Coping with short-staffing staffing Prioritize you assignments Organize your workload Be a team player make a rule that no one can sit until everyone can sit. Pitch in and help others. Use unlicensed personnel wisely Encourage family participation

29 Coping with short-staffing staffing Inform and involve nursing administration Communicate effectively and nicely Take care of yourself Maintain a positive attitude attitude is everything. If you go into a challenging situation with a positive attitude you can achieve great results. A negative attitude can bring down the morale and performance of the entire team.

30 Scenario Assume that you are the RN leader of a team with one LPN and one nursing assistant on the 7A-3P shift at an acute care hospital. The three of you are responsible for providing total care to 10 patients. Prioritize the following list of 10 things you need to accomplish this morning. Use a 1 for the first thing you will do and a 10 for the last. Be prepared to rationalize your priorities.

31 Check MAR against the orders. Listen to night shift report Take brief walking rounds to assess the night shift report and to introduce yourself to patients. Hang four 0900 IV medications. Set up the schedule for breaks and lunch among your team members. Give the 0845 pre-op on patient going to surgery at Pass the 0830 breakfast trays. Read charts of patients who are new to you. Check 0600 blood sugar lab results for 0730 insulin administration.